Provider Demographics
NPI:1891896866
Name:SCHMIDT, RANDY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:ALLEN
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:KINSLEY
Mailing Address - State:KS
Mailing Address - Zip Code:67547-1340
Mailing Address - Country:US
Mailing Address - Phone:620-659-2302
Mailing Address - Fax:
Practice Address - Street 1:600 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:KINSLEY
Practice Address - State:KS
Practice Address - Zip Code:67547-1340
Practice Address - Country:US
Practice Address - Phone:620-659-2302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSC-3511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS007210OtherBLUE CROSS BLUE SHIELD
KS007210Medicare ID - Type Unspecified
KST77079Medicare UPIN